NCLEX-PN
NCLEX Trainer Test 7 Questions
Extract:
Question 1 of 5
The nurse is caring for a client admitted to the hospital with right lower lobe (RLL) pneumonia. On assessment, the nurse notes crackles over the RLL. The client has significant pleuritic pain and is unable to take in a deep breath in order to cough effectively. Which nursing diagnosis would be most appropriate for this client based on this assessment data?
Correct Answer: B
Rationale: Ineffective airway clearance is defined as the inability to cough effectively, directly supported by the assessment data of crackles and ineffective cough.
Question 2 of 5
The teaching plan for gay or lesbian parents who want to disclose their homosexuality to their children should include all of the following instructions except:
Correct Answer: D
Rationale: Children of gay and lesbian parents should be reassured that their relationship with their parent will not change because of the discussion.
Question 3 of 5
A client with end stage renal disease has been managed by peritoneal dialysis. Which finding should be reported to the doctor immediately?
Correct Answer: B
Rationale: Complaints of abdominal pain, nausea, fever, and return of cloudy dialysate should be reported to the physician since they are indications of peritonitis. Diminished or slow return of dialysate, as mentioned in answer A, is managed by having the client turn side to side or move about to facilitate return flow, so it is incorrect. Answers C and D are favorable findings that do not require intervention; therefore, they are incorrect.
Question 4 of 5
The nurse is caring for a client who is postoperative day 1 after a cholecystectomy. Which of the following findings should the nurse report immediately?
Correct Answer: B
Rationale: A temperature of 100.8°F suggests infection, a serious post-cholecystectomy complication. Options A, C, and D are normal: pain is expected, bile drainage is typical, and urine output is adequate.
Question 5 of 5
After abdominal surgery, a client has a nasogastric tube attached to low suctioning.
Correct Answer: B
Rationale: Nausea and decreased flow suggest possible NG tube obstruction. Aspirating gastric contents with a syringe confirms tube placement (pH 0-4) and checks for blockages, addressing the cause of symptoms. Irrigation should use normal saline after placement confirmation, and antiemetics or tube replacement do not assess tube function.